Virgin Posting: O&G

Exhausting
Intense
Frustrating

Some of the various emotions one (I) experienced during my O&G posting here in KK, Sabah.

I knew it would be hard but never really knew how hard it would be.

First few days during tagging, I was depressed, tired and severely demotivated. Tagging puts us to work from 6.30am - 11 pm / 9pm. And during those times without transportations of our own, we were stuck in the hospital going back later than we meant to hithcing rides from Jai (MANY THANKS, UNREPAYABLE), and pirates (drebar keta).

How we suffered then.

Learning curve was steep. You were meant to learn to present cases well, refer early from PAC, post case for emergency caesarian, refer cases to pediatricians, collect information for statistics presentations, work fast enough. HORDES of mothers burst through the doors, and more offsprings burst through their *ahem* with some ending up not so favourably. And I was almost constantly screwed left right by my superiors. I was in constant fear. Of screwing up somewhere. Leaving a baby dead or ill, not acting fast enough to prevent a threatening maternal condition, not documenting enough, not presenting well enough in morning prayers missing information. I screwed up a lot.

Sometimes I felt like quitting. Alot of times I felt like quitting.

But I didn't. Not like I could.

So I held my head up high, because my pride demands me so, and do my best in whatever I could do. Which I believed later resulted in trust, respect and friendship among my superiors.

The posting also required teamwork and this put a tight bond among us, at least during work which forged new friendships. A lot of the people I met were of variable races, ages and in the midst of work, they matter not. Helping each other out was rewarding a lot of times whenever I can.

Despite what others say about O&G, I found it ironic that deep inside, I sort of enjoyed the posting. I built me up, toughened me somehow, and provided with a lot of experience I needed even though personally I did not think i learned enough.

If I could go back in time, I would like to spend more time doing a lot more Caesarian sections, cuz my current skill sucks. I'd like to perform more ERPOC on my own, and perform pipelle samplings and deliver more twins and breech. Not just for the fun of it, but because the skill is essential later on in the course of my work whether I'll end up in O&G or not.

My personal thanks to everyone I met. Nurses, fellow housemen, medical officers, specialists, consultants, patients, never ever forget the patients I've met. Without them, I would not come this far although I haven't actually gone anywhere far at all.

The last few days were fun, with O&G charity and O&G night.

My prayers that O&G dept, SWACH will continue to prosper and improve.

PICS

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Been Awhile

Haven't written anything for sometime.

Since I'm in the mood, might as well =D

Happy Cancer Ward

Took charge of the GyneOnco ward for the past 2 weeks.

And its one of the liveliest I've been through! Despite having cancer, undergoing chemotherapy and radiotherapy, the patients are mostly cheerful and laughing. They are very friendly to us doctors. And some of them comel sangat! Seriously, its like taking care of big kids.

I'd like to think the condition is mostly due to our happy go lucky Dr Mary, our GyneOnco Specialist, who's strict with her time and care for patient's but at the same time maintain a cartoony and goofy part that makes her funny a lot of times. But mostly I like to think that patients over here (Sabah) are just like that, happy go lucky in nature.

I definitely had fun during my rotation here. Work's pretty relaxed too compared to the other wards.

Today one of my MOs treated all the patients with Conetto. Houseman not allowed to have some though but its ok. It's because watching patients happily licking on icecream is a wonderful sight. It's really adorable!

I recall one time my patient told us during rounds how she didn't mind spending money on supplements. "Kamu guna duit beli handfon, Iphone, barapa lama boleh hidup untuk guna? Kesihatan lagi penting." She told us that. What positive thinking.

On the sadder side, some patient's really look pathetic. I pity one who had feces pouring out her vagina due to a rectovaginal fistula she developed, from the cancer? or the radiotherapy shes being given? And patient's with no veins that us HOs have to poke multiple times and cause endless pain... "Duduk hospital makin sakit ada..." And some patients are dirt poor and they come a thousand miles away from treatment, that even after finishing treatment they have no money to pay to get back home. Chemotherapy cost thousands depending on the regimens. Treating cancer is not cheap. And it breaks your heart to see a recurrent case, cancer cells lying dormant after all that surgery and chemotherapy, the breaking news is indeed heartbreaking.

Taking care of a cancer ward opens everything. Your eyes, heart especially. Try switching places. You with the patient. Your mother with the patient. Will things be different?

Will it still be a happy cancer ward?

The Hands That Heal... Is not mine

Doctor's hand has the ability to heal people.

Rubbish.

My hands and the patient's are just the same, except for our fingerprints (subhanallah, a miracle), and whatever anatomical differences.

It cannot heal. Only Allah may heal people. My hands can only be guided to do good. Or bad.

If we look back retrospectively, how much good have we done with the hands given to us? Being doctors, we have that responsibility to use our hands for good and never for harm unless the benefits outweighs the harm such as in surgery. Our hands have that scary potential of causing harm to our patient's whom trust us to touch them. Very few occupation allows us to touch another person when that other person is not Muhrim or related to us. So heavy a doctors responsibility with his or her hands.

Since I started working as a doctor, oh how many mistakes I have caused, and the repercussions only Allah knows. I pray that Allah guide my hands to do good and avoid harm to self and others.

Peripheral neuropathies and rheumatoid arthritis bites. I pray that our hand function well so that we can continue to do good with them Insyallah.

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Changing Perspectives of People

Being a student, houseman, we tend to 'fear' certain MOs, specialist, consultants. When we fear these certain individuals, we avoid them, we paint very negative views of them, and we infect others with that views so that these people will carry a bad name wherever they go.

I think its not fair to them despite them being damn malignant, and moody. Sometimes we get a scolding for no reason, although I would like to think most with reasons. But these people may actually be nice if you talked to them and meet them outside of work. They are humans too, and being human they have their own characteristic that we may not like but however have to bear.

Here's an experience of mine.

A colleague of asked to switch oncalls with me as he had something that day. Thing is, that call was with an MO with a 'negative' reputation. HOs shudder at his name, and try as best as possible to avoid him. I heard of him even before I started my posting. My colleague couldn't find any other replacement as nobody wanted to be oncall with him. I accepted and just vowed to do my best whatever happens. Gotta face it someday anyway.

And guess what? I went through the oncall without any scolding at all. He listened to my presentations and we communicated well (I think). He even thought me how to do an ERPOC, which nobody wanted to do with him. All I had to do was to call him and ask his permission to perform the procedure and he said OK.

He did scold a few other of my colleagues (some quite severely) but somehow I went through well.

That colleague of mine who changed calls with me said a few days earlier that quite stuck to me, "If you do your work well, and did your best, you have nothing to fear and cannot be scolded. Even if you are, take it as a learning process."

Face it, we'll face people like this at anytime in our life. We just have to deal with them and there is no use in judging someone negatively as you will only react negatively which in the process make life more miserable, for you. I don't think the person gives a damn anyway.

It's easy for me to say this, but it's also a lesson for me.

It's not nice when people paint a negative perception of you. Try thinking positive and see things in a different light, and Insyallah things will improve and work will become less stressful.

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Imperforate Hymen

A Pediatric Surgery / O&G Interest

I didn't see the patient myself but when I heard it being presented in the morning prayers, I just had to at least go read the case note.

One of the common causes of primary amenorrhea, usually presenting with cyclical abdominal pain, like dysmenorrhea only without the menses. Easily missed diagnosis although easy to make.

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11yo female child with no menses yet presented with history of progressive abdominal distension for 2 months associated with abdominal and back pain. She has no fever and other constitutional symptoms.

Examination reveals an abdominal mass measuring a 24 week size uterus, which was mobile side to side and could not get below the mass.

Examination of the perineum clinched the diagnosis of imperforate hymen. Before this the differential was ovarian and uterine mass.

TAS shows hematometra and hematocolpos. (Something like below although this image was taken from medscape)


Hymenectomy was done. Surgery was uneventful and patient was discharged well the day after the surgery.

For more:
http://emedicine.medscape.com/article/954252-overview

Polyhydramnios - Spectrums

I've decided to write on interesting cases here. In the future I'll decide if they would be included in the travelogue.

Polyhydramnios - Spectrums

Case 1

22yo Primid @ 26W + 3D

Late booker

Referred for further management of fetal anomaly seen in TA scan and reduced fetal movement.

Patient was aysmptomatic, not in labour. V/S were normal. Per abdomen SFH was 30W size, with difficulty to papate the fetal parts and positive fluid thrill. There were no contractions.

TAS revealed:

- Dilated fetal heart. Still beating.

- Fetal ascites.

- Empty mother's Morrison's pouch.

What are other TAS features to look for?

What is the probable diagnosis?

What are the investigations to be performed in this case?

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Case 2

28yo, G4P3 @ 38W+1D

Antenatal problems: Anemia in pregnancy, AFI normal throughout pregnancy, no GDM, fetal anomaly scan not done.

Came in active phase of labour.

V/S stable

PA: Ut size: 38W, singleton, cephalic, head 5/5 floating, difficult to plapate the fetal parts/

Admitted to labour room for controlled ARM. CTG was reactive prior to admission.

On rupturing the membrane, 1.5 L of liquor was drained with fresh blood stains. CTG worsened showing unprovoked decelerations.

Impression was placenta abruption secondary to ARM.

Posted for EMLSCS.

Intraoperatively uneventful.

Baby boy delivered with BW 2.1kg. Admitted to NICU for TTN. Later discovered to have tracheoesophageal fistula, imperforated anus. Planned for thoracotomy, TOF repair and colostomy my the peds surgery team.

Mother was well post-op.

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Maybe I'll write a bit on polyhydramnios when I'm a bit in the mood. I find both cases interesting. There was another with hydrops fetalis but I didn't note the case.

Other cases of polyhydramnios I'm on the lookout for are:

- diabetic causes

- Twin-twin transfusion

- Other fetal anomalies (ie. Spinal disorders due to problems swallowing)

The Backbone of the Wards - Nurses

Hada request from a friend to write about nurses in Sabah (she's a nursing student) and compare them to Peninsular Malaysia nurses. She hears them grudgingly back talk about doctors almost everyday and would like to hear from me if there's any difference.

I think its human nature to back talk whether they mean it or realize it. I'm not encouraging it but just acknowledging its existence. Yes it exist here. Not just among nurses, but among doctors as well. Nurses back talk that arrogant houseman, houseman backtalks that malignant specialist, patients backtalks that nurse. Sometimes you don't hear it, you just sense it. Makes you wonder what people talk or think of you behind you back.

But so far I enjoy working with the nurses here. Its too early to make a general overall conclusion but the nurses I've met are really helpful and most are fun to work with. The labour room staff are a cheerful bunch. They offer food and invite us to Raya at their place. They are the ones who cover our asses and remind us of jobs. They tell us the correct dose for medications and help teach us stitch. The nurses I've met taught me Caesarian section. I have a feeling they'd be able to perform a better C-sec than most new MOs if only they had the license to do so. Most importantly they keep the wards organized and in-check. I believe them to be more professional than most doctors regardless of rank.

Prof Nasa was right. You should treat your nurses you work with with RESPECT. They are not down the food chain. We work together to achieve a common goal. This would be much easier if everyone did not talk behind each others back and be suspicious of each other.

I love my nurses. Make them love you too.

Oh, nurses in KK I've met a lot are pretty and cute too =D

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Malignant Potential

My colleagues sees me being a potential malignant MO.

When compared to IIUM students back home in Kuantan, I less commmonly see UMS students around in the hospital. But when they are around, I do my best to share what I know, tutor style. Apparently, my style of asking questions and waiting for answers got me branded for being potentially malignant.

Back in medical school, most teachings and learning were from making you think. The process occurs better when triggered by a question and those asked finding the answer. Some lecturers ask in a sarcastic or aggressive way. These are the malignant ones. But I still think that these types of teachings are the best. It conditions you. By being scolded, you are more likely to look for the answer in the hope that when next time occurs, you are able to answer and deal with the situation better.

How different it is in the working life? No different. Only that your actions have repercussions. You are still scolded like a little child when you make mistakes. But again, this is another learning process that the mature will take as a lesson instead of as a personal insult. MOs gets the same treatment, specialist gets the same treatment. Always questions first. Makan suap does not suit the medical field. Its how we are trained.

So I don't think becoming malignant that way is that bad. Hell if that will make my apprentices better, than malignant I shall be. But I'll try not to let emotions dictate my actions. Besides, I''m not known to marah orang.

Right? >:D

Sabah Raya, Bah!

Initially we all (UIA team :p) volunteered to work throughout Raya since its too late to buy cheap tickets back anyway. But our beloved Suthagar insisted that we took a few days break saying how he understands how sad it is when someone doesn't come back for Raya.

Thanks alot! We still didnt go back to visit our family but we did had a whole lotta fun!

I planned early with Khairie who's coming back to Renau so that I could follow him and birng my UIA buddies as well. Initially only Nadhir agreed to come along. That Raya night we traveled through mist covered winding mountain roads where the only thing that was visible was the mist and a few centimeters of white line on the road. We could easily run into a car, a wall, or a cliff. But we made it :D

Our Sabah Raya was with Khairie's family. After Raya prayers, we had the usual stuff (I wouldnt know what the usual Raya stuffs are) with me having vege some meat and chicken. and lotsa pineapple tarts! Binge!! Yea and birdwatching in between and the whole time (But I FORGOT MY BINOCS!!!!! which I asked Jazmi whom decided to come along anyway to help bring for me [more on birds in my bird blog]).

After that we went to Kundasang Kinabalu park, took a 200m hike which raised my PR to 140bpm (pancit da panjat ni imagine Gunung Kinabalu!). Saw more birds. Then stopped by a War Memorial on Brits and Aussies whom died after a long march from Sandakan to Renau by the Japs during WW2.

Had KFC. Ayam Renau. And later that evening pampered ourselves at the Poring hotsprings.

That night had a noob game of DoTA I vow never to play again.

Next day we went to Sabah tea garden, where I had omelette du fromage and my first hot lemon tea sedap nak mampous! while watching birds and taking in the pretty scenery. Then took a bath with them fishes serious tak penah buat anything like this! I like had hundreds of fish sucking on my fingers and other body parts (not that).



Then the search for Strawberry farm. Didnt find it but we reached New Zealand with 2 million cows!!!! APA??! 2 JUTA?

On the way to the tip of the world (tip of Borneo sorry for the hyperbolism), stopped by Kota Belud for ayam Kota Belud at KFC.

Then we reached a pretty beach spot. A lotta birds and pictures later we decided to stay the night a chalet. Noice!

Drove down a dark, rocky, dead road to Kudat town. If our car broke down memang were done for. Had dinner at the town and took a different road back and relaxed and sucked in the sea air and went to sleep...

More birds and long rock pool and beach trek to look for even more birds before we had breakfast and went back the long road back to KK...

Bah.

Recommended places:
- Kundasang and Renau just for the spectacular view
- Kinabalu Park
- Poring HotSprings
- Sg Kg Tagal and Fishes
- Sabah Tea Garden
- Tip of Borneo

Brother's visit

My brothers, Shafiq and Iyas, dua2 duo xley blah came to visit me here in KK.

I switched oncalls with Jeriol so Id be free as much as possible on the weekends to spend time with me bros.

The day we came we ate at New york New York, a nice western place I always wanted to try. They serve tall rootbeer floats and steak. Later that night went to Tanjung Aru and had some chicken wings. Bro said it was better than dominoes. I agreed.

Next day took a sudden trip to Manukan island. Man the waters clear! I was so enticed I walked straight in to the sea that I forgot about my BB in my pocket. The end of that BB. Still had fun feeding the fishes. Later we went to a not so nearby crocodile farm. They sell croc meat there! Besides crocs there were some other animals as well. Nice to feed and pet. Even the Bearcat =)

Balik tido.

Later that night tried out a fishfood joint my bro's friend recommended. Sedap gila bab! Serious Ive never enjoyed seafood as much as I did that night. But it was all over the next day and oncall... Sent my bros to the airport. babai...

Hiatus

I have been writing but not on the net cuz had no net connection but my BB which has..... expired.

Now I'll try restart.

to come (when time permits)

-network and luck
-first day of life
-all friends no foes (not yet)
-so many moms and babies!

Intro: Travelogue

This has been planned even before my final professional examination. I was impressed by the travelogue that we have written during our travels to Yogjakarta during our electives and inspired by several Islamic books written by Muslim authors. Among books I was inspired by were Muhammad Asad's Road to Mecca, and Murad Wilman Hoffman's, Journey to Islam: Diary of a German Diplomat, and Leadership Role of Muslim Scientists by Dr Wan Hazmy Che Hon, a local Orthopaedics specialist among the few books I was inspired by.

There are few or no (more research needed on this one) articles or books on the life of housemen in Malaysia. This puts fresh houseman in the dark, struggling with the first few days and not knowing what to prepare before hand.

During the holidays before the start of work, I have sort of made preparations for myself, physically, mentally and hopefully most important, spiritually. I have made a mental list of things I need to prepare for in the hope that things would not be too daunting as I enter this new life. I am very much sure that whatever I have prepared thus far will not be enough. So it is my intentions to go through housemanship and hopefully go through it well to live to tell the tale. Or rather to share my experiences so that hopefully the readers are able to learn from them.

This will not be a medical book. Rather Insyallah I shall attempt to chronicle my journey through this challenging phase of life (or so I was told), the experiences, the hardships, my musings, the people I shall come to meet and know, the state of Sabah (if I do go there), and whatever else that comes to mind.

I shall try breaking it into small pieces (I don't think I have time to write a lot anyway) so that it'll be easy and enjoyable on me and the readers. Important points will be published here in this website / blog in point forms as I have done for my holidays (Postexam, Prework)

The end result I hope shall be published for those interested. It is my hope that this work shall be a pioneer among later works although I don't think I am either the first or the last to embark on this exciting trip.

My prayers to Allah that I manage to complete this work, that I persevere, that I do not forget, that I shall always remember Him, and that He has promised peace after hardship.

Meanwhile please suggest a nicer title for the book =)

Assalamualaikum.